Pediatrics CME

These areas are covered:
Goal Directed Therapy ,Early Goal Directed Therapy, Hemodynamic Monitoring, Glucose Monitoring / Diabetes and Critical Care Pharmacology.

Some recent titles are:
• Making the Case for Glycemic Control: Is it a Matter of Tightness or Timing?
• Advanced Hemodynamic Monitoring
• Cardiac Output Monitoring vs. TEE/TTEGoal-Directed Therapy in the Operating Room
• Physiologic Optimization Program: Physiology Based Fluid Management
• Extravascular Lung Water: Clinical Implications
• Critical Care Pharmacotherapy Literature Updates
• Severe Sepsis: Early Recognition & Management Saves Lives
• The Use of Dynamic Parameters in Perioperative Fluid Management
• Current Trends in Management of Blood Glucose in Type 2 Diabetes Mellitus

Target Audience: Physicians focusing on Anesthesiology, Critical Care, ER, Hospital Medicine, and Pediatrics (ICU).

Almost every week, a lecture is videotaped and uploaded to the site within a few days.

Some examples include:
• Preparing for Disasters – The Role of the General Pediatrician
• Supporting Breastfeeding Dyads: the Pediatrician’s Role
• Seven Doctors Project: Creative Writing Workshops for Healthcare Workers
• Residency Now and Into the Future

Target Audience: Pediatricians

Examples of top articles include:
• Diagnosis and Management of Food Allergies
• Issues in Neonatology
• Child and Adolescent Mental Health
• Pediatric Nephrology
• Outlook on RSV: Emerging Science
• Adolescent Sexuality
• Cases in Pediatric Dermatology
• Infection Protection: New Insights and Ideas for Assessing and Treating Bacterial Conjunctivitis
• Outlook on RSV: Emerging Science
• Child Abuse Pediatrics

Target Audience: Pediatricians

You will find five areas presenting new CME on a monthly basis:

Cardiology Corner activities include a combined slide and audio presentation, as well as mp3, mp4, and a non-audio option.

Supplemental Reading/References provide links to abstracts.

Grand Rounds contains evidence-based topic presentations and discussions.

The Radiology Wing and Pathology Gallery presents a new picture or X-ray.

The Ultrasound Wing features case presentations with ultrasound images. Instruction is via a brief text or graphics case followed by online discussion among the users and then a brief multiple choice test.

Target Audience:
PED (Neonatology), Maternal and Fetal Medicine (Perinatology).

The major focus of this site is Global Health.

Examples of modules include:
• Module 1: Introduction to Health Care for Immigrant and Refugee Populations
• Module 2: Disaster Response and Clinical Medicine in Resource-Limited Settings
• Module 3: Public Health and Noninfectious Disease in Developing Countries
• Module 4: Parasitic Infections
• Module 5: Bacterial, Mycobacterial (TB), and Fungal Infections
• Module 6: Viral Infections
• Module 7: Travel Medicine

You will also find 2 courses unrelated to global health:
• Nitrous Oxide for Pediatric Procedural Sedation
• FASD: Early Identification and Intervention in the Primary Care Setting

Target Audience:
Physicians focusing on Family Medicine, Infectious Disease, Internal Medicine, Preventive Medicine, and Pediatrics.

Activity Description / Statement of Need:

In this online, self-learning activity:

Hemophilia is a genetic disease caused by mutation of one of the genes for coagulation proteins leading to dangerous, uncontrolled bleeding. In hemophilia B, a mutation in the gene for factor IX (FIX) leads to an endogenous deficiency in the clotting factor. The incidence of hemophilia B is the same in all geographic regions, populations, and ethnic groups, affecting approximately 1 out of every 30,000 male births. The condition is diagnosed by measuring FIX activity, and patients with severe hemophilia have levels of 1% or less. Patients with severe hemophilia B are at risk for spontaneous, life-threatening bleeding episodes. Untreated, the life expectancy is approximately 20 years, and painful or even life-threatening morbidities include: intracranial hemorrhage, severe bleeding in other organ systems, musculoskeletal injury, and joint injury. In contrast, in people with moderate or mild hemophilia, abnormal bleeding usually occurs after minor trauma or surgery. Unfortunately, the literature shows that not only do clinicians struggle with the classification of hemophilia severity and that there are gaps in knowledge present that contribute to delayed diagnosis and treatment, with an attendant increase in morbidity and mortality. Challenges in diagnosis and classification are only the first of several gaps in care that patients with hemophilia face.

Target Audience:

The following HCPs: hematologists and pediatricians; physician assistants, nurse practitioners, and pharmacists who practice in hematology, and other HCPs who practice in hemophilia treatment center; and any other clinicians with an interest in or who clinically encounter patients with hemophilia B.

Activity Description / Statement of Need:

In this online, self-learning activity:

Pompe disease (PD) is a progressive, often fatal, autosomal recessive, neuromuscular disorder caused by mutations of the α-glucosidase gene on chromosome 17. PD is characterized by glycogen accumulation in skeletal, cardiac and smooth muscles due to a deficiency in α-glucosidase (GAA), an important lysosomal enzyme responsible for glycogen catabolism. PD is categorized into three groups based on symptoms and age of onset. The classic infantile form presents in the first year of life, usually in the first two months, with hypertrophic cardiomyopathy. The non-classic infantile form presents later in the first year of life, without or with less severe cardiomyopathy. The late onset form of PD presents any time after one year of life, usually without cardiac complications.

PD is rare, with one study estimating the incidence in the U.S. to be 1 in 22,000 births. The biggest risk factor for the disease is genetics; at conception, each sibling of an affected individual has a 25% chance of being affected, a 50% chance of being an asymptomatic carrier, and a 25% chance of being not a carrier. Nonspecific diagnostic findings for PD may include abnormal EMG, elevated serum creatine kinase, elevated transaminases and elevated lactate dehydrogenase. A definitive diagnosis for PD involves a dried blood spot test to determine GAA enzyme activity level; reduced GAA activity (less than 40% of normal) is indicative of a positive diagnosis. A gene mutation analysis, or another GAA enzyme test using a different area of tissue, is recommended to confirm the diagnosis. The disease is not uncommonly undiagnosed or is misdiagnosed, representing one practice gap that continued HCP education may address, particularly given that earlier treatment may minimize rapid and irreversible disease progression.

Target Audience:

The following HCPs: Neurologists, pediatricians, and primary care physicians; physician assistants and nurse practitioners in those areas of specialty; pharmacists who practice in specialty pharmacies that treat patients with rare diseases; and any other HCPs with an interest in or who may clinically encounter patients with PD.

Activity Description / Statement of Need:

In this online, self-learning activity:

Mucopolysaccharidoses (MPS) are a group of genetic diseases characterized by a deficiency of lysosomal enzymes responsible for the hydrolysis of glycosaminoglycans (GAGs), resulting in a variety of clinical manifestations in patients presenting with MPS. MPS has several subcategories, and MPS type I (MPS I) arises from the inheritance of an alteration in the IDUA gene, which encodes for alpha-L-iduronidase. Affecting an estimated one in 100,000 live births, MPS I is categorized as either attenuated MPS I (also known as Scheie or Hurler-Scheie syndromes) or severe MPS I with cognitive impairment (also known as Hurler syndrome).

Progressive in nature, MPS I is associated with multi-organ complications and sequelae. Patients exhibit a spectrum of clinical presentations, including facial deformities, organomegaly, cognitive impairments, upper airway obstructions, skeletal deformities, and cardiomyopathy. The burden of MPS I is considerable, with reports of caregivers contributing 51 hours per week on average to help patients perform daily activities of living. Quality of life for patients and their caregivers is significantly reduced with MPS I, affecting the social, emotional, and financial well-being of a family. It is reported that parents fear for their child’s delayed language acquisition, ability to fit in amongst peers and the society, fear of the expense for the necessary care, and fear for the death of a child from obstructive sleep apnea.

This learning activity has been designed to bring HCPs’ knowledge of the strategies for treatment and management of MPS I up to date and to improve their competence and performance in treating it.

Target Audience:

The following HCPs: Pediatricians, neurologists, endocrinologists, genetic disease specialists; physician assistants, nurse practitioners, and pharmacists in the aforementioned areas of specialty; and any other HCPs with an interest in or who may clinically encounter patients with MPS I.

Acne is one of the most common skin conditions treated by physicians, affecting 40 to 50 million people in the U.S. Although the disease can affect patients at any age, acne occurs most commonly during the adolescent years, with a prevalence as high as 85%. In 20% of cases, the acne is severe, resulting in permanent physical scarring as well as a mental health burden. That burden may include increased prevalence of mood disorders, psychiatric hospitalizations, school absenteeism, unemployment, and suicidality.

Acne is a multifactorial inflammatory disease affecting the hair follicles of the skin. While an understanding of acne pathogenesis is one that is continuously evolving, key pathogenic factors include follicular hyper-keratinization, microbial colonization, sebum production, and complex immune and inflammatory mechanisms. Other research suggests that neuroendocrine regulatory mechanisms, diet, and genetic and factors all may contribute to the multifactorial process of acne pathogenesis. Professional guidelines for the treatment of acne vulgaris in adolescents and adults highlight the roles of topical and systemic pharmacotherapies as well as non-pharmacologic treatment modalities, including lasers and photodynamic therapy. However, in the time since the guidelines were published, newer medications have been approved or entered late stage clinical investigation. Communicating related information to HCPs in a timely manner is a demonstrated need.

Primary immunodeficiency disorders (PIDD) comprise a group of 430 different known inborn errors of immunity. The heterogeneous etiology of PIDD leads to a vast array of clinical presentations, including infection, malignancy, autoimmunity, and inflammation. Once thought to be exceedingly rare, PIDD is increasingly being recognized as an underdiagnosed disease affecting between one in 1,000 to one in 5,000 births.

Because a significant percentage of people with PIDD are undiagnosed, improving the recognition of PIDD signs and symptoms necessarily forms the foundation of PIDD-focused medical education efforts. Early treatment improves outcomes and health-related quality of life in children and adults with PIDD, yet time from symptom onset to diagnosis can exceed 4 years. Diagnostic lag has serious consequences for many patients with PIDD due to recurrent infections, which may take a toll on pulmonary function. In a large-scale analysis of patients with common variable immunodeficiency, a common form of PIDD, risk of death increased by 1.7% each year of diagnostic delay.  The most up-to-date guidance around the classification of PIDD and how to determine related genetic tests has been published relatively recently. Communicating related information to HCPs in a timely manner is a demonstrated need.